Provider Demographics
NPI:1295849834
Name:BHUSHAN, SUJATA (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SUJATA
Other - Middle Name:
Other - Last Name:UPADHYAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-1588
Mailing Address - Fax:214-857-1575
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:BLDG 2,3RD FLOOR,ROOM B333
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 38426207R00000X
TXM7861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine